Journal

Scars: a guide to what can be done to treat them

Dr A Bolin

From aloe vera to green tea, laser to skin needling, Dr A Bolin takes a look at what really works when it comes to minimising and treating scars.

Some see beauty in asymmetry and unique traits such as scars. Others obsess over symmetry as mainstream fashion norms and social media flood us with daily visuals where Photoshop filters out perceived imperfections.

Scars are often overlooked and not considered an urgent medical issue. However, they can be itchy, red, dry, painful and lead to a myriad of emotional disturbances such as insomnia, depression, low self-esteem, anxiety.

This can lead to distress, lack of self confidence and an overall decreased quality of life. Appropriate diagnosis, prevention and treatment can make an enormous difference to your appearance and health. Fortunately there are several options for you to address care of your scar: so let’s see what can be done.

Scars: the many different types

A scar is connective tissue that is mainly made up of fibroblasts and later develops into a dense matrix of collagen fibres. They can be flat, sunken, hypopigmented (light coloured), hyperpigmented (darkened/reddish), hypertrophic (enlarged) or keloids (when the scarring extends beyond the borders of the original area affected).

If a scar develops then contracts, it can be painful and difficult to treat.

Keloid scar

What types of treatments are available for scars?

Your treatment depends on what type of scar it is. A dermatologist or plastic surgeon needs to see what diagnosis is, then decide what treatment is appropriate for the individual and the specific scar. There are topical as well as injectable options. If these treatments fail, under certain circumstances excision of the old scar is considered.

Topical treatments

Many advertisements promote oils and creams to get rid of scars. In general many surgeons say it is the massaging of the oil into scar that helps break up the scar tissue. But can the ingredients help too? Let’s see what the research says.

The evidence base for the use of many current treatments is poor, and some may have only placebo benefit. Onion extract has antioxidant properties and is used in several scar treatment creams. Aloe vera, commonly found in many moisturisers, has anti-inflammatory properties and helps hydrate the skin. Although widely believed to be beneficial, some research has shown vitamin E to be effective whilst other studies have found it no better than placebo.

Green tea extract

There is a growing body of evidence however to suggest that a concentrated extract of Green tea known as EGCG, can help shrink scars and reduce redness. It is a powerful antioxidant found in plants.

One study conducted by Manchester University showed it reduced scar size by up to 40% while another study showed it significantly reduced the thickness and redness of a scar in just two weeks in a clinical trial in volunteers.

(Results showing scar shrinkage after treatment)

According to the scientific skin biologist and co-founder of SOS Solution for Scars, Dr Ardeshir Bayat the study compared the treatment of scars created by punch biopsy in 20 volunteers.

The biopsy created identical scars in each of the patients in terms of size and depth. The cream with the EGCG was applied for 14 days and the results were compared to the results from a ‘placebo’ – or cream with no active ingredient. None of the volunteers or those who gave out the cream knew who had been given the ‘active’ cream.

The study shows topical EGCG can play a role reducing redness and skin thickness in scar tissue.

Silicone

There is good evidence that silicone (gel or sheets) helps with the healing process and improves scar appearance. It prevents the scar from drying out and hydrates the skin, allowing better healing to occur.

Chemical peels

Chemical peels with glycolic or salicylic acid can be quite useful in treating acne scarring but always make sure your practitioner is well trained and qualified to perform the peel as they can burn the skin.

What about injectable steroids into the scar?

If your scar is hypertrophic or a keloid, there is a significant amount of inflammation that occurs. Injecting steroid into the scar can help flatten and decrease this inflammation which can often make the scar itchy and painful. The injections are normally given once every 4-6 weeks and usually three treatments are required.

Can laser treatments help improve scars?

It depends on the scar. Laser or light therapy (pulses of light) is known to really help with evening out red pigmentation due to its ability to reduce the amount of blood vessels in the area. It can be sometimes uncomfortable or painful. It can be used in certain circumstances to help resurface the skin promoting new elastin and collagen production to improve the appearance of slightly sunken (depressed) or pitted scars from conditions such as acne.

According to the NHS there aren’t many studies to prove its effectiveness over time or its safety. Always make sure your practitioner is a fully trained medical practitioner with experience in treating scars.

Can cryotherapy help?

Cryotherapy uses liquid nitrogen to deep freeze a hypertrophic or keloid scar. There is good evidence that it can help flatten and minimize these scars. The procedure may be painful (which can be overcome by using a local anaesthetic), and depending on the size of the scar can take weeks to heal after treatment. Also, sometimes the skin might end up hypopigmented (lighter in colour) after the treatment.

I have scars with crevasses, do dermal fillers work?

Yes, they can help. However, bear in mind that depending on the scar the overall appearance may not be completely smooth and uniform. Also, the changes will not be permanent. They will need to be re-treated once the body has reabsorbed the filler. How long it lasts varies with each individual but it could last 9-18 months.

Can skin needling to help resurface the skin?

Skin needling is a technique where small tiny needles are rolled over the skin causing small punctures. This stimulates elastin and collagen production through the skin’s repair mechanism. It is moderately effective at improving some of the pits and dips that occur in acne scarring. People with a tendency toward keloid scarring should avoid this treatment.

What if none of these work?

Well, in certain cases, cutting out the old scar by an experienced dermatologist or plastic surgeon may help. It’s always a good idea to get a plastic surgeon or dermatologist to take a look at scars as they will have the best idea on how to treat them.

It is important to have realistic expectations when it comes to scar treatments. While there are many techniques to improve the appearance of scars it may not disappear completely. But remember, treating your scars is only one part of improving your self-esteem. There are many psychologists who can help you if you have issues concerning you appearance and build you can help build your confidence by focusing on a healthy lifestyle, diet, exercise and making time for mindfulness in order to achieve a better quality of life.